Who's in charge when I'm billed incorrectly?
First you should contact the billing department of the Practice, Hospital, or other entity that billed you incorrectly. Then follow-up all phone conversations with a written summary of the conversation, and send it to whomever you spoke with. If you cannot get resolution from the initial contact, then I suggest asking to speak with the Supervisor, and/or person in charge of the Billing Dept.
I would also ask for a complete, itemized billing, for all services provided, whether they are services covered by your insurance company or not. I would then contact the insurance company's benefit coordinator, and ask for an explanation of benefits as it pertains to this particular billing. In a lot of cases, the insurance company will direct to you to contact the Physician's Group to handle billing inquiries and problems. They generally don't get involved until there is an unresolvable situation.
After that, I would recommend that you contact of their Physicians, Hospitals, Radiological groups, etc., that provide the same services you received, and ask for their rates for services if provided by them, including use of your insurance and the capitated or contracted pricing. If there is any difference in the rates charged by two or more entities, then bring it to the attention of both the company that originally billed you, and your insurance company or physicians group. Ask if you can negotiate the rates down to equal what the other companies are charging, and offer to pay in full at the lower rate, today.
If they don't cooperate, you may have to issue a complaint to the company, the physician's group, the insurance company, any local advocacy groups, plus any known associations they may be governed by.
Ask for and thoroughly read all pamphlets and handouts for dealing with complaints and /or negotiations. Usually they are handled through binding arbitration. At any rate, they are required to provide you with step by step instructions on how to file a complaint, and whom to send it to.
Depending on the amount of monies involved, you may want tot contact the Department of Corporations, Health Care Division. They are very slow to respond, but they are very thorough in their investigations.
Additionally, this is one of the few times I would recommend bringing in the Media. Almost every T.V. station has some form of consumer watchdog to assist people in dealing with multi-layered corporations. Take advantage of their assistance and guidance.
The most important thing is to be persistent. Do Not leave everything up to someone else. Follow up with every person involved and keep meticulous notes regarding all conversations, phone calls, etc., including names, dates, times, a brief summary of what was discussed, along with any and all copies of correspondence from or to you regarding this matter. Not letting things fall through the cracks is vitally important right now. Stay on top of all correspondences, and return all calls as soon as possible!
Reread all correspondences with dates and deadlines. This is very important. Do not let a deadline lapse, or you could automatically lose your case. If there is any discrepancies regarding days and/or dates, ask for clarification in writing. Ask that any letters be rewritten to clarify the error. I almost lost my case over a supposed "typo". So don't be fooled by their tactics -- always keep your notes and records current. Meet all deadlines. And don't accept anything is final until you've reached the final binding arbitration.
These companies are large and can easily afford to jerk you around. And they will. They will repeatedly ask for the same information and swear they never received it. I strongly recommend that all correspondence be sent certified. That way, you have a signed receipt for everything sent, including tracking numbers. It's a lot more difficult to say they didn't receive something when you have their signature and the date saying they did! Keep all receipts attached to your copies of the correspondence, etc., sent. Keep a chronological file or notebook with all information from beginning to current.
I know that it seems an awful lot of wasted time, space and money. But believe me it will be beneficial in the end. However, having said that, if you're fighting over $10 - $20 , you may want to consider all the time, money, and effort you'll put into fighting. While I believe in fighting on principle, you do have lots of things you could better spend your time and money on. So, please at least consider whether the fight is really worth the effort or not.
Trying to keep track of your health care when things are handled properly can be a full time job. Especially for those of us whom are trying to say ahead on the health wheel of life, it can be a daunting and overwhelming job! So, when something out of the ordinary needs extra attention, or something wasn't dealt with properly to begin with, you've put yourself behind the eight ball to keep up with all the phone calls, and correspondence necessary to correct the problem. For instance -- I had a balance billing problem from a capitated plan item.
If this was only once out of every 10-20 times I get billed, I wouldn't complain so much. But, it's gotten so bad that I pay my PCP by carbon check and still ask for a receipt. Even then, I am still regularly billed by the bookkeeper for payments I've already paid. It's quite frustrating to have to always be the one person who provides all the evidence either way. If I pay, I paid. Copies of cancelled checks should be sufficient. If I haven't paid because I wasn't billed correctly, well shouldn't I deserve all the same courtesies? Just move on! But no, that's too simple. I have to make several calls to different people to clarify the issue. Then when they don't agree, then I have to appeal their ununanimous decision in writing! And, just to be fair, there's a time limit for appeals. So no taking your time. You either appeal now or forget it.
But it's not just health care anymore that has this attitude. Try to talk with your local Tax assessor about a billing error where you've been over assessed, plus never actually received a bill to begin with. Talk about being stuck up to your neck in red tape, plus a tax code bible you have to read through to find a reason for them to consider listening to an appeal, to begin with. It doesn't make any difference if they screwed up or not, they assume it will eventually be corrected, and until then you have no recourse, unless you can find a loop hole in their code book. Just what I've always wanted, to read up on Tax Code Assessments! Yippee!
My mission although I didn't sign up for, is to endure all those crazy incidents you hear about from friends and coworkers. You know, those ones about the person who spent 15 hours in the waiting room at some hospital emergency ward. Or, even better, the one where this person sold health care policies only to find themself fighting for their life with the healthcare company just months before had been singing their praises. How's that for irony. Well, we all know the sob stories. I'll try to keep those to a minimum, and only when absolutely necessary for a point, but this is about all those crazy inconveniences that the healthcare industry as a whole puts the average person though on a daily, no hourly, basis, without thought, care or much consideration whatsoever. It's shameful. Why is my time and effort worth so little, especially when I'm paying you to provide a service to me. Why then is it necessary to fight tooth and nail just to get what I paid for? Is anybody listening? Well I certainly am listening, and screaming at the top of my lungs to anyone who'll listen to me. We need a grass roots campaign started like yesterday. We need someone whose on our side of the argument for once. Help out with your own stories and comments. Or, just try to keep me from going to far up on my soapbox. I truly hope I can help someone, open people's eyes to the craziness, and maybe make some small change in how heathcare treats us!